Haemoglobin and Serum Iron Responses to Periodic Intravenous Iron-Dextran Infusions during Maintenance Haemodialysis

Stewart, W. K.; Fleming, Leanne; Shepherd, Alexander M

doi:10.1159/000180717

Cited by 24 publications

(9 citation statements)

References 9 publications

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“…In the United States and elsewhere, parenteral iron injections are advocated as the preferred route for anemia correction in chronic renal failure either alone or in combination with recombinant erythropoietin [12, 13, 14, 15, 16, 17]. When administered in combination with erythropoietin, parenteral iron injections purportedly enhance the response to erythropoietin, and consequently erythropoietin requirements may decline, resulting in substantial short-term cost savings [8, 13, 15].…”

Section: Indicationsmentioning

confidence: 99%

“…Whether this proposition holds in patients with chronic renal failure on hemodialysis – that response to parenteral iron may depend on the amount of dialysis they receive – is unclear. Unfortunately, the effect of dialysis dose on the response to intravenous iron-dextran infusions was not stated in any of the studies on parenteral iron use in patients with end-stage renal failure [8, 13, 14, 15, 16]. …”

Section: Response To Therapymentioning

confidence: 99%

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Parenteral Iron: Pharmacology and Clinical Use

Ifudu

1998

Nephron

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Section: Indicationsmentioning

confidence: 99%

Section: Response To Therapymentioning

confidence: 99%

Parenteral Iron: Pharmacology and Clinical Use

Ifudu

1998

Nephron

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“…Early studies were able to demonstrate the benefits of parenteral iron, given either as a total dose infusion or by intramuscular injection, despite the limitation imposed by the lack of adequate iron preparations as well as poor dialysis efficacy [8, 9]. Most of these studies were similar to our own in that patients were not receiving concomitant EPO [10, 11].…”

Section: Discussionmentioning

confidence: 78%

Experience with the Use of an Iron Polymaltose (Dextrin) Complex Given by Single Total Dose Infusion to Stable Chronic Haemodialysis Patients

Zyl-Smit

Halkett

2002

Nephron

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Background: Many studies of anaemia in patients on chronic haemodialysis have noted a high prevalence of iron deficiency despite oral iron supplementation. Our study examined the effect of intravenous iron given as bolus replacement. As the majority of these patients were not receiving concurrent recombinant human erythropoietin (rhEPO) it allowed an analysis of the safety and efficacy of intravenous iron as a single agent. Methods: All patients with a haemoglobin level of less than 10 g/dl and considered iron deficient by the finding of a percentage transferrin saturation of less than 20% were given intravenous iron in the form of iron polymaltose (dextrin) by total dose infusion (TDI). The dose was calculated from tables supplied by the manufacturers. Patients with serum ferritin levels in excess of 225 ng/ml were excluded. Results: In our unit, 62 out of 80 (77%) patients were considered iron deficient and received IV iron. Ten (10%) were considered to be in iron balance and 8 (10%) had biochemistry suggesting iron overload. None of the patients receiving iron experienced any adverse reactions. At three months a rise in haemoglobin level of at least 1 g/dl was noted in 53% of patients. The response was less in the remainder, but only 2 showed no response. Conclusions: Low levels of iron deficiency are often unrecognized in chronic haemodialysis patients on conventional therapy including oral iron supplementation. In such patients, the use of total dose infusion of iron polymaltose (dextrin) is a safe and effective method of raising haemoglobin levels. Substantial improvements may be achieved without the concurrent use of rhEPO.

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“…that response to parenteral iron may depend on how well they are dialyzed, is unknown. Effect of dialysis adequacy on the response to parenteral iron injections was not stated in any of the studies of parenteral iron use in patients with ESRD [12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Relative Contributions of Body Iron Status and Uremia Severity to Anemia in Patients with Advanced Chronic Renal Failure

Ifudu

Dawood

Friedman

1997

Nephron

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Anemia in chronic renal failure is predominantly caused by diminished erythropoietin synthesis by diseased kidneys. While iron deficiency is often stated as a cause of anemia in chronic renal failure prior to end-stage renal disease, its relative contribution is debated. It is speculated that rather than frank ‘iron deficiency’, many patients with chronic renal failure may indeed have impaired utilization of iron. We analyzed 139 consecutive patients with chronic renal failure starting maintenance hemodialysis to determine the relationship between hematocrit, measures of renal function (blood urea nitrogen and serum creatinine concentration), and measures of iron availability (serum transferrin saturation, serum iron level and serum ferritin). The 139 study subjects (60 men, 79 women) comprised 116 blacks (83%), 15 hispanics (11%), and 8 whites (6%) of a mean age 56 ± 15 years. Only 23 (17%) of 139 subjects had positive hemoccult stool test for blood. Their mean hematocrit was 24 ± 4.5%, mean blood urea nitrogen concentration was 121 ± 38, mean serum creatinine concentration was 12.6 ± 5.2 mg/dl, mean serum transferrin saturation was 22 ± 14%, mean serum ferritin level was 235 ± 194 U/l, mean serum iron level was 55 ± 40 U/l, and mean total iron binding capacity was 254 ± 93%. Multiple regression analysis with hematocrit as the outcome variable, and blood urea nitrogen level, serum creatinine concentration, serum albumin concentration, serum transferrin saturation, and serum ferritin level as the independent variables, showed an inverse correlation between hematocrit and serum creatinine concentration (p = 0.002). We conclude that in patients with chronic renal failure starting uremia therapy, anemia does not correlate with any of the commonly measured indices of body iron stores. We infer that impaired utilization of iron may be a significant factor in the anemia of chronic renal failure.

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Haemoglobin and Serum Iron Responses to Periodic Intravenous Iron-Dextran Infusions during Maintenance Haemodialysis

Cited by 24 publications

References 9 publications

Parenteral Iron: Pharmacology and Clinical Use

Parenteral Iron: Pharmacology and Clinical Use

Experience with the Use of an Iron Polymaltose (Dextrin) Complex Given by Single Total Dose Infusion to Stable Chronic Haemodialysis Patients

Relative Contributions of Body Iron Status and Uremia Severity to Anemia in Patients with Advanced Chronic Renal Failure

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